December 10, 2020
This fourth installment of DPR Construction’s COVID-19 briefing series delves into the insights provided by industry partners and clients related to challenges, solutions, and lessons learned that the healthcare industry generated in response to the pandemic.
COVID-19 exposed a number of limitations within the healthcare industry, pointing to the clear need to build more flexibility into planning, design, and construction of healthcare facilities.
The effects of COVID-19 were seen and addressed throughout the hospital environment:
- externally with the development of crisis testing protocols
- internally with bed capacity during surges, and length of stays
- within the hospital infrastructure, with the need to quickly provide containment and isolation, maintain supplies, repurpose systems and spaces
- operationally, with modified workflows and with the disruption of health systems’ financial models through the cancellation of elective procedures and surgeries.
Intake procedures needed to quickly accommodate the need to keep potentially infected patients isolated from other patients and medical staff.
DPR’s partners noted that commencing care outside of the hospital facility was a quick way to start isolating COVID-19 cases. The result is that many facilities now begin emergency department registration curbside, or with a screening space at the facility entrance to decrease congestion while commencing with isolation protocols.
New uses for mobile apps are being employed as it has been found that smartphone registration is faster and even more accurate than web-based apps. Mobile triage tents could be installed and made flexible by using portable privacy screens. Discussion participants also mentioned separated ingress and egress patterning becoming much more important and how enhanced and clear signage are key to keeping patients and visitors on safely separated paths.
The sudden need for additional and isolated hospital beds required nimbleness as well. Field hospitals went up quickly in many locations. While not utilized to the extent expected, field hospitals could have alternative uses if not necessary for incoming surge patients. Discussion participants noted that in some places they were adapted for the lower end of care. One alternative was to use them or those who could be transitioned out of an acute setting, but who were not ready to go home. The hospital beds were then kept available for those in the acute stages of the disease.
Due to their higher cost to build, hospitals typically have only a handful of negative pressure rooms for isolation cases. One engineer brought up the fact that value engineering targets the systems behind the wall first, yet those systems are vital to scaling during a crisis such as this pandemic. Still, discussion participants offered several examples of quick or temporary solutions to increase negative pressure spaces, with the lesson learned to at least have some temporary solutions ready to go if the flexibility needed is not already built in:
- To purify the air, use mobile photocatalytic air purifiers that use UV light.
- To quickly convert rooms to negative air pressure, implement mobile HEPA filters combined with reverse flow fan filters.
- To provide permanent anterooms as a dividing space for containment and patient isolation. As they flank the isolation rooms, they can provide a safe area for doffing PPE.
- To support the temporary negative pressure rooms and provide a safe space for doffing PPE, portable, reusable anterooms were brought in.
Another lesson learned discussed by participants was how to alleviate the loss of revenue that hospitals and systems are now facing, due to cancelled elective surgeries.
The CARES Act helped mitigate the financial hit through early summer. For systems, one solution was to segregate hospitals within the system and divert the elective surgeries to a non-COVID facility when capacity allows. Another, which does require regulatory cooperation, is to shift some surgery to lower-acuity outpatient facilities, as has been demonstrated successfully within certain fields such as ophthalmology and dermatology. Discussion turned to policy, regulation, and major operational changes that may be considered to drive more transparency and competition.
One key lesson mentioned was that of asset management. As one participant said, “You need to know what you have, to know what you need.” There are many software solutions available for electronic tagging, tracking, and maintaining machinery and equipment. The discussion group added other assets that should be assessed, including infrastructure and space. A space assessment can assist with determining spaces that can be realigned for patient flow or repurposed for isolation. And modular prefabricated walls can be quickly implemented to alter a space as needed. “Modular structures can separate infectious patients and other available spaces can also be customized for a specific region or patient population,” commented Sean Ashcroft, one of the healthcare core market leaders for DPR Construction.
What Silver Linings Lie Within These Lessons?
Reacting to the lessons learned from COVID-19 has given the industry the kickstart it needed to pivot and change.
DPR and its partners agree: this is a chance to reset and reduce overall health costs, improve access to healthcare and reimagine space utilization. As a global issue, COVID-19 has also made the world a smaller place, and there has been increased access to sharing and learning from all corners. New industry partnerships offer greater transparency and collaboration and the value of connections has never been more important.
Hamilton Espinosa, DPR Construction healthcare core market leader, summed it up: “Every situation is unique, but it all comes back to the ability to be flexible, creative and adaptable while we work together to get through this great challenge and look forward with what we have learned.”